- Laurea magistrale in Medicina e Chirurgia cum Laude, Università Cattolica del Sacro Cuore di Roma (2018)
- Specializzanda di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario IRCCS Agostino Gemelli (2024)
- Fellowship in Paediatric Orthopaedics, Deformity Reconstruction, Foot Surgery and Orthopedic Oncology (O.. . Reinhard Windhager and . Madeleine Willegger, FEBOT), University Hospital Vienna (AKH) - Medical University of Vienna (MUW) (2024)
- Dottorato in Scienze Oncologiche, Università Cattolica del Sacro Cuore
RESEARCH, TEACHING, or OTHER INTERESTS
Orthopedics and Sports Medicine, Pediatrics, Perinatology and Child Health, Oncology
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Scopus Publications
Scopus Publications
Integrating vosoritide therapy with limb surgery in paediatric patients with achondroplasia: real-life experiences A. Allegri, M. Bedeschi, M. B. Bocchi, Valentina Camurri, M. Gonfiantini, C. Leoni, M. Mariani, Osvaldo Palmacci, Matteo Porro, Simone Riganti, Caterina Tedesco, Berardo Rinaldi, E. Scarano, Concetta Schiavariello, Angelo Selicorni, Stefano Stagi, Fabio Verdoni, Giuseppe Zampino, Mohamad Maghnie, R. Onesimo Orphanet Journal of Rare Diseases, 2025 BACKGROUND: Achondroplasia is the most common form of disproportionate short stature and can lead to serious medical complications, including foramen magnum and spinal stenosis. Until 2021, there were no precision treatments available, and in some countries, elective surgery was considered a standard approach to increase height, improve body proportions, enhance functionality, and correct deformities in a selected group of patients. Recently, C-type natriuretic peptide (CNP) has been explored as a potential treatment, aiming to counteract the molecular activity driven by FGFR3. Although post-market and real-world data on the drug are still limited, many questions remain about the potential for combining pharmacological and surgical therapies and how this might influence patient outcomes. Concerns have also been raised regarding the potential impact of drugs on bone healing. However, anecdotal evidence from orthopaedic practice suggests that the two ossification processes do not interfere with one another. The aim of this study was to describe the first real-world case series in which vosoritide treatment was integrated with limb surgery in children and adolescents with achondroplasia. RESULTS: Sixteen paediatric patients with molecular confirmation of achondroplasia were included in the study. All patients underwent combined vosoritide therapy and limb surgeries (13 for lower limb lengthening and 3 for varus correction through epiphysiodesis).The complementary roles of vosoritide therapy and surgery were highlighted, with treatment outcomes aligning closely with expectations. CONCLUSION: This report provides the first clinical description of the combination of precision therapy with limb surgery in a relatively large multicentre cohort of paediatric patients with achondroplasia. These findings support continued exploration of the integration of different therapeutic approaches.
Osteosarcoma: A Comprehensive Morphological and Molecular Review with Prognostic Implications Alessandro El Motassime, Raffaele Vitiello, Rocco Maria Comodo, Giacomo Capece, Guido Bocchino, Maria Beatrice Bocchi, Giulio Maccauro, Cesare Meschini Biology, 2025 Osteosarcoma (OS) is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults. Despite advances in surgery and multi-agent chemotherapy, survival rates for metastatic or recurrent OS remain poor, highlighting the need for novel prognostic and therapeutic strategies. This review integrates histopathologic, molecular, and immune perspectives to provide a comprehensive understanding of OS biology in the context of precision medicine. We discuss classic morphologic and radiographic features alongside recent insights into the tumor microenvironment, including the role of tumor-infiltrating lymphocytes, tumor-associated macrophages, and immune checkpoint expression. Emerging molecular markers, such as gene expression–based immune risk signatures, circulating tumor DNA, and gasdermin D overexpression, are evaluated for their prognostic and therapeutic relevance. Key dysregulated pathways, including WNT/β-catenin and JAK/STAT, are examined in relation to metastasis, chemoresistance, and immune evasion, with emphasis on current targeted approaches under development. By bridging histopathology, immunogenomics, and translational research, this work outlines how integrated biomarker assessment can refine patient stratification and guide the implementation of individualized treatment strategies in OS.
Epidemiology and Treatment of Metastatic Lesions Around the Elbow: A Systematic Review Andrea De Fazio, Giovan Giuseppe Mazzella, Guglielmo Miele, Maria Beatrice Bocchi, Omar El Ezzo, Giacomo Capece, Giulio Maccauro, Raffaele Vitiello Journal of Clinical Medicine, 2025 Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes.
FPG Score: A Rapid Admission-Based Tool for Predicting In-Hospital Mortality in Elderly Hip Fracture Patients Marcello Covino, Guido Bocchino, Maria Beatrice Bocchi, Chiara Barbieri, Benedetta Simeoni, Antonio Gasbarrini, Francesco Franceschi, Giulio Maccauro, Raffaele Vitiello Orthopaedic Surgery, 2025 ObjectiveHip fractures in elderly patients are a major public health concern, associated with high morbidity and mortality. Early identification of high‐risk patients is crucial to guide clinical decision‐making, optimize resource allocation, and improve outcomes. However, existing risk prediction models, such as the Nottingham Hip Fracture Score (NHFS) and the Charlson Comorbidity Index (CCI), require laboratory or postoperative data, delaying risk stratification. This study aims to develop and validate the FPG score, a novel and simplified tool for predicting intrahospital mortality in elderly patients undergoing surgery for proximal femur fractures, using only admission data available at triage.Materials and MethodsThis single‐center, observational cohort study was conducted in two phases: a retrospective derivation phase (2015–2019) and a prospective validation phase (2020–2022). Patients aged ≥ 65 years with proximal femur fractures (AO 31A, 31B) undergoing surgical treatment were included. Exclusions involved pathological, periprosthetic, and femoral head fractures (31C). Data on demographics, comorbidities, vital signs, and laboratory values were collected at Emergency Unit triage. The primary outcome was intrahospital mortality. Univariate and multivariate logistic regression identified predictors, and ROC analysis assessed the FPG score's predictive performance, with AUC, sensitivity, and specificity evaluated using SPSS v25 and MedCalc v18.ResultsIn the retrospective phase, 1984 patients (median age: 83.5 years, 28.7% male) were analyzed, with an observed intrahospital mortality of 3.8% (77 patients). The FPG score demonstrated an AUC of 0.79, outperforming NHFS and CCI. A score > 2 was associated with a > 50% mortality risk, with 61% sensitivity and 80% specificity. In the validation cohort (752 patients, 4.8% mortality), the FPG score maintained strong predictive performance (AUC = 0.751).ConclusionThe FPG score provides a rapid, objective, and clinically applicable tool for mortality risk assessment in elderly patients with hip fractures, allowing for immediate triage‐based decision‐making. Unlike NHFS and CCI, it does not require laboratory or post‐admission data, making it particularly useful in emergency settings. Its integration into clinical practice may enhance patient management, improve resource allocation, and facilitate early intervention. While the score has been validated in a single‐center study, further multicenter validation is needed to confirm its broader applicability. Future research should explore the integration of frailty indices and laboratory markers to refine its predictive accuracy.
Comparison of bilateral tibial lengthening with circular external fixator and simultaneous deformity correction with hexapod external fixator in Achondroplasia Maria Beatrice Bocchi, Osvaldo Palmacci, Raffaele Vitiello, Cristina Giuli, Antonio Ziranu, Giulio Maccauro European Journal of Medical Genetics, 2025 Achondroplasia is a growth plate dysplasia caused by FGFR-3 gene mutation. In addition to dysmorphic short stature, genu varum is very common. Therefore, a certain part of the achondroplasic population is interested in extensive cosmetic limb lengthening and deformity correction to achieve a functional height so that they can attain total autonomy in everyday life. All patients who underwent bone lengthening treatment from March 2014 to December 2022, were retrospectively analyzed in terms of inclusion and exclusion criteria. To determine any angular deformity in the coronal plane, the Mechanical Axis Deviation was calculated. Patients were divided into two groups: group A included patients who had no angular deformity and therefore performed exclusively cosmetic bilateral tibial lengthening, group B included patients undergoing cosmetic lengthening and simultaneous bilateral multiplanar correction of tibial deformities with hexapod external fixator. The achieved distraction, the external fixator index and the consolidation index were calculated and compared for the two groups. Any adverse event was recorded. According to inclusion and exclusion criteria, 14 patients (28 tibias) diagnosed with Achondroplasia were included (20 tibias group A and 8 tibias group B). We found a statistically significant difference between the two groups regarding the mean age at the time of surgery (p 0.01). The mean MAD value within group B showed a substantial improvement from 56.50 ± 19.1 mm to 14.6 ± 5 mm. Comparing the two groups, we observed a statistically significant difference between both preoperative (p 0.0001) and postoperative (p 0.006) MAD values. The difference found between the two groups was significant also in terms of mean external fixator index (35.9 days/cm versus 52.5 days/cm) and consolidation index (24.2 days/cm versus 37.9 days/cm). Comparing the adverse events found in the two groups no significant differences emerged (p 0.7). In the context of cosmetic lower limb lengthening program for achondroplasic patients, most studies have focused on linear lengthening often underestimating the importance of any associated deformities correction. In our experience, the genu varum correction with the hexapod system showed relevant results in term of MAD improvement. Our results show a significant difference between the two groups in consolidation (p 0.002) and thus also in external fixation (p 0.001) time to the disadvantage of the hexapod group probably due to: higher age (p 0.01) with lower healing potential, greater difficulty in weightbearing and in dynamizing the fixator.
Multi-Ligament Reconstruction in an Adolescent Female Affected by Congenital Femoral Deficiency and Complete Anterior and Posterior Cruciate Ligament agenesis: A Case Report Simone Giusti, Maria Beatrice Bocchi, Edoardo De Fenu, Osvaldo Palmacci, Ezio Adriani Clinics and Practice, 2025 Purpose: Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. Methods: We present a complex case of a 16-year-old girl affected by congenital femoral deficiency and ipsilateral tibial hypoplasia who was treated successfully for a complete agenesis of the anterior (ACL) and posterior (PCL) cruciate ligament with single-sitting ACL and PCL reconstruction. Results: The adolescent patient was successfully reconstructed with excellent clinical results. Conclusions: Knee MRI (Magnetic Resonance Imaging) should be requested in all patients affected by congenital femoral deficiency to exclude ligamentous agenesis. Where present, these should be reconstructed at an early stage as soon as limb-lengthening procedures are completed. If still skeletally immature, physeal-sparing surgical techniques should be implemented.
Roles and Applications of Circulating Tumor-Derived RNAs in Sarcoma Patients: A Systematic Review Elena Gabrielli, Maria Beatrice Bocchi, Cristina Giuli, Francesco Farine, Doriana Di Costa, Giulio Maccauro, Raffaele Vitiello International Journal of Molecular Sciences, 2024 Sarcomas are a heterogeneous group of malignancies with a high mortality rate. Detection of circulating tumor-derived material, such as circulating RNA in the peripheral blood of patients, has shown to be useful in diagnosis, prediction of prognosis and disease monitoring in several malignancies. This systematic review aims to probe the existing methods for detecting circulating tumor-derived RNAs from patients affected by sarcoma and their possible clinical application. A systematic review of the literature indexed in PubMed was performed. Each article had to analyze circulating RNA in human specimens obtained from liquid biopsies of patients affected by sarcoma. A total of 26 articles were included. We evaluated 1381 patients; 72% were affected by bone sarcoma and 28% by soft tissue sarcoma. By PCR-based methods, all the studies investigated circulating tumor RNA, mostly in the peripheral blood. Nearly half of the authors investigated the tumor expression and/or release of miRNA (42%). Several authors pointed out that circulating tumor-derived RNA has proven to have potential application in a clinical setting for sarcomas. To the best of our knowledge, this is the first review in the literature to attempt to put together data specifically on ctRNA in patients affected by sarcoma.
Skeletal anomalies in Gorlin-Goltz Syndrome: a systematic review Maria B. BOCCHI, Osvaldo PALMACCI, Cristina GIULI, Antonio ZIRANU, Giulio MACCAURO, Raffaele VITIELLO Minerva Orthopedics, 2024 INTRODUCTION: Gorlin-Goltz Syndrome (GGS), which is also well-known as nevoid basal cell carcinoma syndrome, is a rare entity consisting of ectodermal and mesodermal abnormalities. It is a rare genetic disorder with the autosomal dominant inheritance which shows high penetrance and variable expressivity. The protein patched homolog gene mutation is held responsible for the etiology and leads to multi-organ disorder. The syndrome is characterized by the classical triad of odontogenic keratocysts, multiple basal cell nevi and skeletal anomalies. Early diagnosis is important to reduce the severity of the complications, especially regarding tumors. Due to the wide clinical spectrum, treatment and management are not standardized and should be individualized and monitored by a multidisciplinary team.EVIDENCE ACQUISITION: A systematic review of the literature indexed in PubMed MEDLINE and Cochrane Library databases using as search terms “Nevoid Basal Cell Carcinoma AND Gorlin Goltz” was performed in September 2023. To be considered for this review at least a section of the population understudy needed to be affected by GGS and have at least a skeletal abnormality. Literature focused on maxillofacial manifestations/surgery were excluded.EVIDENCE SYNTHESIS: Forty studies met the inclusion criteria and were included in the review. The reached population consisted of 62 patients (66.1% were males and 33.9% were females). Among the skeletal abnormalities we found 41.9% bifid/spread/fused ribs, 17.7% wedged/fused vertebrae, 14.5% scoliosis, 11.2% Sprengel and 9.7% pectus deformities and 11.2% syndactyly of the digits. No surgical approaches to the skeletal problem were described.CONCLUSIONS: The extreme phenotypic variability of these patients is extremely characteristic and is also expressed at the skeletal level. Although skeletal anomalies are widely represented in this population, due to their “benign” nature they often move to the background. The radiologist and the orthopedic surgeon are fundamental in the recognition of these abnormalities that allow the patient to be directed toward a correct and timely diagnosis, and potentially lifesaving.
Characteristics and Epidemiology of Megaprostheses Infections: A Systematic Review Luigi Cianni, Francesco Taccari, Maria Beatrice Bocchi, Giulia Micheli, Flavio Sangiorgi, Antonio Ziranu, Massimo Fantoni, Giulio Maccauro, Raffaele Vitiello Healthcare Switzerland, 2024 Background: Megaprostheses were first employed in oncological orthopedic surgery, but more recently, additional applications have arisen. These implants are not without any risks and device failure is quite frequent. The most feared complication is undoubtedly the implants’ infection; however, the exact incidence is still unknown. This systematic review aims to estimate in the current literature the overall incidence of megaprosthesis infections and to investigate possible risk/protective factors. Methods: We conducted a systematic search for studies published from July 1971 to December 2023 using specific keywords. To be included, studies needed to report either the megaprosthesis anatomical site, and/or whether the megaprosthesis was coated, and/or the surgical indication as oncological or non-oncological reasons. Results: The initial literature search resulted in 1281 studies. We evaluated 10,456 patients and the overall infection rate was 12%. In cancer patients, the infection rate was 22%, while in non-oncological patients, this was 16% (trauma 12%, mechanical failure 17%, prosthetic joint infections 26%). The overall infection rates comparing coated and uncoated implants were 10% and 12.5%, respectively. Conclusions: The number of megaprosthesis implants is increasing considerably. In traumatological patients, the infection rate is lower compared to all the other subgroups, while the infection rate remains higher in the cancer patient group. As these devices become more common, focused studies exploring epidemiological data, clinical outcomes, and long-term complications are needed to address the uncertainties in prevention and management.
Pathological Fractures in Patients Affected by Pycnodysostosis: A Case Series Maria Beatrice Bocchi, Cristina Giuli, Francesco Farine, Camilla Ravaioli, Sara Martellini, Pasquale Farsetti, Osvaldo Palmacci Journal of Clinical Medicine, 2024 Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is responsible for an increased risk of fractures. The purpose of our study was to evaluate the orthopedic manifestations and potential pitfalls in the surgical treatments of pathological fractures in a series of patients treated in our institution who were affected by pycnodysostosis. Methods: We retrospectively evaluated clinical and radiographic characteristics of five patients with pycnodysostosis treated for pathological fractures at our hospital in the past 5 years. Results: Two male and three female patients were included in this study. Four patients had a family history of pycnodysostosis. All the patients were of short stature, but only two underwent growth hormone treatment. All the patients experienced fractures, mostly in their lower limbs and occurring as a result of low-energy trauma. Most of the patients experienced either consolidation delay or nonunion. Conclusions: The orthopedic management of fractures in patients with pycnodysostosis poses an ongoing challenge for orthopedic surgeons. The fact that the bone is simultaneously sclerotic and brittle makes any orthopedic surgical treatment challenging and at a high risk of nonunion in any case.
Induced membrane by silver-coated knee megaprosthesis: Keep or toss? Journal of Biological Regulators and Homeostatic Agents, 2020
Arthrodesis in the charcot foot: A systematic review Luigi Cianni, Maria Beatrice Bocchi, Raffaele Vitiello, Tommaso Greco, Davide De Marco, Giulia Masci, Giulio Maccauro, Dario Pitocco, Carlo Perisano Orthopedic Reviews, 2020
Foot metastasis: Current knowledge Tommaso Greco, Luigi Cianni, Domenico De Mauro, Giacomo Dughiero, Maria Beatrice Bocchi, Gianpiero Cazzato, Giulia Ragonesi, Francesco Liuzza, Giulio Maccauro, Carlo Perisano Orthopedic Reviews, 2020